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Deadline is January 31st for Eligible Physicians to Request Exemption From Electronic Prescribing Incentive Program Penalty

Thursday, January 17, 2013

Eligible physicians who were unable to file for a Medicare Electronic Prescribing (eRx) hardship exemption by the original deadline have until January 31, 2013 to avoid the 1.5 percent Medicare payment penalty in 2013.  Please note: Many anesthesiologists are automatically excluded from the incentives and penalties associated with the program.  The Centers for Medicare & Medicaid Services (CMS) will automatically exclude from the penalty if the physician does not have at least 100 Medicare Physician Fee Schedule (MPFS) cases containing an encounter code in the e-prescribing measure’s denominator for dates of service from 1/1/12-6/30/12. These encounters are predominantly evaluation and management services and can be found in the measure specification.  Also, CMS will automatically exclude the eligible professional that does not have 10% or more of their MPFS allowable charges for encounter codes in the measure’s denominator for dates of service from 1/1/12-6/30/12.  Please click here to view the e-prescribing measure specifications.  In these cases a physician does not need to apply for a hardship exemption

The eRx program and hardship exemption are particularly applicable to our ASA members who issue prescriptions to patients, such as pain physicians.  Significant hardship requests should be submitted via the communications support webpage.

Physicians may request a waiver of the 2013 penalty under any the following hardship exemption categories:

  • The physician is unable to e-prescribe as a result of local, state, or federal law or regulation.  In some cases, electronic prescriptions for controlled substances may be subject to such laws or regulations.
  • The physician wrote fewer than 100 prescriptions during the period of January 1 through June 30, 2012.
  • The physician practices in a rural area that doesn't have sufficient high-speed Internet access.
  • The physician practices in an area that doesn't have enough pharmacies that can do e-prescribing.

CMS also added two hardship categories for those participating in Medicare’s electronic health record (EHR) meaningful use program:

  • Eligible professionals who achieve meaningful use during certain eRx timeframes. For 2013, this includes any eligible professional who achieved meaningful use during January 1, 2011 through June 30, 2012 and attested to this by January 31, 2013.
  • Eligible professionals who demonstrate intent to participate in the EHR Incentive Program and adopt Certified EHR Technology by registering for the EHR Incentive Program by January 31, 2013. 

The eRx Incentive Program is a reporting program that uses incentive payments and payment penalties to encourage eligible professions to use electronic prescribing.  The program provides incentive payments to practices with eligible professionals who successfully e-prescribe for covered Medicare services.  Beginning in 2012, the program applied a 1 percent Medicare payment penalty to eligible professionals who do not successfully e-prescribe for these services. However, eligible professionals may be exempt from the payment penalty if being a successful eligible prescriber would result in a significant hardship. Learn more about the CMS eRx program.

Physicians can contact CMS’s QualityNet Help Desk at (866) 288-8912 or via email with questions or for assistance submitting their hardship exemption requests. Support is available from 8 a.m. to 8 p.m. Eastern time Monday through Friday.

Physicians who use Apple computers may experience technical problems; CMS encourages them to contact the Help Desk for assistance.

Hardship exemption requests for the 2014 payment penalty will be accepted during a separate period later this year.

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